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Canadian Journal of Gastroenterology and Hepatology
Volume 2016, Article ID 1980686, 9 pages
Research Article

Altered Esophageal Mucosal Structure in Patients with Celiac Disease

1Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada L8S 4K1
2Department of Medicine, “Dr. Carlos Bonorino Udaondo” Gastroenterology Hospital, 1264 Buenos Aires, Argentina
3Favaloro University Hospital, 1093 Buenos Aires, Argentina
4Consejo de Investigación en Salud, MSAL, Gobierno de la Ciudad Autónoma de Buenos Aires, 1425 Buenos Aires, Argentina
5Gastroenterology Chair, Universidad del Salvador, 1056 Buenos Aires, Argentina

Received 23 December 2015; Accepted 28 December 2015

Copyright © 2016 María Inés Pinto-Sánchez et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background/Aim. Reflux symptoms (RS) are common in patients with celiac disease (CD), a chronic enteropathy that affects primarily the small intestine. We evaluated mucosal integrity and motility of the lower esophagus as mechanisms contributing to RS generation in patients with CD. Methods. We enrolled newly diagnosed CD patients with and without RS, nonceliac patients with classical reflux disease (GERD), and controls (without RS). Endoscopic biopsies from the distal esophagus were assessed for dilated intercellular space (DIS) by light microscopy and electron microscopy. Tight junction (TJ) mRNA proteins expression for zonula occludens-1 (ZO-1) and claudin-2 and claudin-3 (CLDN-2; CLDN-3) was determined using qRT-PCR. Results. DIS scores were higher in patients with active CD than in controls, but similar to GERD patients. The altered DIS was found even in CD patients without RS and normalized after one year of a gluten-free diet. CD patients with and without RS had lower expression of ZO-1 than controls. The expression of CLDN-2 and CLDN-3 was similar in CD and GERD patients. Conclusions. Our study shows that patients with active CD have altered esophageal mucosal integrity, independently of the presence of RS. The altered expression of ZO-1 may underlie loss of TJ integrity in the esophageal mucosa and may contribute to RS generation.